Dr. Cortes on Defining Fitness in Patients With Hematologic Malignancies

Jorge E. Cortes, MD, director, Georgia Cancer Center, Augusta University, discusses the importance of defining fitness in patients with hematologic malignancies prior to treatment selection.

It has been difficult to standardize the definition of patient fitness because this is somewhat of a subjective decision, Cortes explains. Moreover, patient fitness alone is not the sole determining factor of treatment. It is also important to take into consideration what a patient wishes to proceed with in terms of their care.

Some patients may physically be fit for chemotherapy, but a patient may prefer an alternative to intensive chemotherapy, Cortes says. This is something that all clinicians must respect if that is their patient’s desire. This respect should be given, even if, for example, the overall survival (OS) of the alternative approach is inferior to the recommended approach––as long as that is discussed with patients. Although OS is often the primary end point of large most trials, patients may place more value on the quality of their survival rather than the quantity in the real world, Cortes explains.

Subjectivity will likely continue in clinical practice, Cortes continues. However, there are tools to assist in a clinician’s assessment of patients. There are methods and models that can help stratify a patient’s fitness in addition to clinical assessment, Cortes says. Importantly, a thorough discussion with the patient is necessary to explain the pros and cons of all treatment options in terms of efficacy and safety, as well as detailed information on the different approaches that are being proposed, Cortes concludes.